国外静脉注射视频Intravenous line insertion

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• Fluids may be infused directly into the circulating blood volume to supplement or replace body fluids
• The goal of intravenous (IV) fluid administration is to correct or prevent fluid and electrolyte imbalances, correct or prevent nutritional imbalances or provide IV medication therapy
• When IV therapy is necessary, nurses must possess many nursing skills including starting an IV, set-up and management of the IV system, identification and correction of problems, and discontinuation of the infusion

For the healthcare provider (nurse, physician): the following considerations are recommended:

• Caution regarding needle sticks and sharp injury
• Concern for the personal safety of health care professionals who work with IV therapy products (possibility of transmission of hepatitis B virus, human immunodeficiency virus/HIV)
• Awareness of the dwell time for pe**heral IV catheters. Note when the IV was started, when the IV tubing and dressing was changed. Pe**heral IV access should be changed every 72-96 hours or more frequently if complications occur
• Early recognition of complications (e.g., redness, edema, infiltration, thrombosis, pain at catheter entrance site); complications require immediate discontinuation of a catheter and rotation of the site
• Knowledge of client's normal range of vital signs before instituting IV therapy
• Knowledge of dominant side (right or left handed); when possible, place an IV in the nondominant arm
• No more than two attempts at initiating the IV access by a single nurse。
• • Correct IV solution
  • Proper IV safety access device for venipuncture (will vary with client’s body size and reason for IV fluid administration)
  • A 20 to 22 gauge flexible catheter is used in most situations for **s whereas a 22 to 24 gauge catheter may be used for children and older **s or for any client with small or fragile veins. A large size (20 or 18 gauge) catheter is preferred to allow rapid infusion of IV fluids or viscous blood product solutions
  • Universal Precautions: gloves, antiseptic swab agent (e.g., alcohol, betadine) to cleanse the site
  • Tourniquet
  • Non-allergenic tape
  • IV pole
  • Sharps container For Heparin or Normal Saline Lock

  For Heparin or Normal Saline Lock

  • Injection cap
  • IV loop or short piece of extension tubing if necessary
  • 1 to 3 ml of normal saline flush
  • Syringes and 25 gauge needles

  Transparent Dressing Only

  • Transparent dressing

  Gauze Dressing Only

  • 2 x 2 or 4 x 4 sterile gauze sponge
  • Sterile tape For Venipuncture for Blood Collection
  • Needle
  • Vacutainer
  • Blood tubes
• Positions/landmarks
• Select vein for IV insertion;
• preferred sites for IV insertion for **s are:
  • cephalic
  • basilica
  • median cubital
• Use the most distal site in nondominant arm
• Venipuncture should be performed distal to proximal which increases the availability of other sites for future IV therapy
• Procedures/steps
  • Review physician’s order for type and amount of IV fluid and rate of fluid administration
  • Nurses: follow the six rights of medication administration
  • Assess for clinical factors/conditions that will respond to or be affected by IV fluid administration
    • Pe**heral edema
    • Body weight
    • Dry skin and mucus membranes
    • Distended neck veins
    • Blood pressure changes
    • Irregular pulse rhythm, increased rate
    • Auscultation of crackles or rhonchi in lungs
    • Skin turgor
    • Anorexia, nausea and vomiting
    • Thirst
    • Decreased urine output
    • Behavioural change
    • Decreased capillary refill
  • Assess client’s previous or perceived experience with IV therapy and arm placement preference
  • Explain procedure to patient
  • Prepare equipment
  • Universal Precautions: open sterile packages using sterile aseptic technique
  • Prepare IV infusion tubing and solution
  • Insert infusion set into fluid bag, remove protector cap from tubing insertion spike, do not touch spike, and insert spike into opening of IV bag
  • Prime infusion tubing by filling with IV solution; compress d** chamber and release, allowing it to fill one-third to one-half full
  • Remove protector cap on end of tubing (some tubing can be primed without removal of cap) and slowly open roller clamp to allow fluid to travel from the d** chamber through the tubing. Close roller clamp once the tubing is primed with IV fluid
  • Ensure that the tubing is free of air and air bubbles. If air and air bubbles are present, tap tubing firmly where air bubbles are located
  • Replace cap on end of infusion tubing
  • Prepare heparin or normal saline lock for infusion
  • Apply disposable gloves
  • Identify accessible vein for placement of IV cannula. Apply tourniquet around arm above anticubital fossa or 4 to 6 inches above proposed insertion site. Check for radial pulse (may use a blood pressure cuff instead of tourniquet)
  • Select well dilated vein. Stroking the extremity from distal to proximal below the proposed site may foster venous distension. Vigorous friction and multiple tapping of the veins, especially in older **s may cause haematoma and/or venous constriction
  • Release tourniquet temporarily and carefully
  • Place connection of infusion set or IV plug nearby maintaining sterility
  • Use antiseptic swab agent to cleanse insertion site
  • Reapply tourniquet 4 to 5 inches above insertion site
  • Perform venipuncture
  • Observe for blood return through flashback chamber of catheter or tubing of winged cannula, indicating that the bevel of the needle has entered the vein. Lower needle until almost flush with skin, continue to hold the skin taut, and advance catheter into vein until the hub rests at venipuncture site
  • Stabilize the cannula with one hand and release tourniquet with the other. Apply gentle pressure with middle finger of non-dominant hand 1.25 inches above the insertion. Keep cannula stable with index finger, slide the catheter off the stylet, remove the stylet, and place directly into sharps container
  • Quickly connect end of the prepared saline lock or the infusing tubing to end of cannula, secure the connection
  • Intermittent infusion: Hold the heparin/saline lock firmly with the nondominant hand and clean with alcohol, insert prefilled syringe containing flush solution into injection cap. Flush injection cap slowly with flush solution
  • Continuous infusion: Begin infusion by slowly opening the clamp of the IV tubing
  • Secure cannula
  • Apply sterile dressing over site
  • Loop tubing alongside the arm and place a second piece of tape directly over the tape covering the transparent dressing
  • For IV fluid administration, recheck flow rate
  • Write date and time of IV placement, cannula gauge size and length and the health care professional's initials (nurse's) on dressing
  • Dispose of all sharps in the appropriate sharps container, remove gloves and wash hands
  • Instruct client how to move or turn without pulling on the IV catheter
  • Pe**heral IV access should be changed every 72-96 hours and more frequently if complications occur
  • When solution has less than 100ml remaining, next solution should be available at the client’s bedside
• Patient education

• Assess client's previous or perceived experience with IV therapy and arm placement preference
• Explain procedure to patient
• In the case of young children, parental presence and distraction techniques are useful to calm anxiety/fear
• Instruct client how to move or turn without pulling on the IV catheter

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